Sexual|Reproductive Health
Lafiyayyan Yara (Healthy Child) – Reducing Infections Disease Among Children Under Five (RIDCU) Bade LGA, Yobe State
The Lafiyayyan Yara (Healthy Child): Reducing Infectious Disease among Children under Five (RIDCU-5) project was a 27-month private donor funded project implemented from October 2021 through December 2023. The project strengthened health systems in Bade Local Government Area (LGA) of Yobe state by providing required equipment and medication for health facilities, increasing capacity of health personnel to use approved diagnostic methods, and engaging the community to improve uptake of health services.
The primary objective of the evaluation was to assess the project's performance and document its achievements, challenges, and best practices to guide future similar programming; and provide recommendations to CARE Nigeria and its partners to make informed decisions and enhance the effectiveness and efficiency of future initiatives.
Effectiveness
Evidence from the desk review showed that the project made remarkable progress towards reducing mortality in under-5 children through a community-based health systems strengthening approach that ensures that communities receive a core package of services. The major factors that influenced the effectiveness and achievement of the project results were the use of community structures (community health volunteers, model mothers, and community-based surveillance focal points), capacity building, the referral system and the Social Analysis and Action (SAA) approach through community dialogues, supportive supervision, routine monitoring visits and facility health promotion session. The SAA approach also helped to shift practices related to family planning, immunization and poor health seeking behavior, as evidenced from the qualitative findings.
Efficiency
In both the design and implementation of the project activities, CARE International RIDCU5 team ensured that the project was efficient. The project design allowed the RIDCU5 project to train and work with community members as volunteers and adequately build their capacity and work collaboratively with local partners and relevant stakeholders. The use of community structures and local partners made the project implementation cost effective and created the opportunity for sustainability.
7
The project’s design engaged community volunteers1 to serve as model mothers, community-based surveillance focal points, feedback and accountability volunteers, and community health volunteers, has enabled the project to increase community mobilization through a cost-effective approach. Through the community referral system, and health promotion sessions, many women were reached through the activities of the community volunteers.
Impact
Findings showed that the objectives and activities of the CARE RIDCU5 project were relevant in addressing the humanitarian needs of Bade Local Government communities. The weekly dialogue session with model mothers helped to address social norms and practices that negatively impact maternal and child health and the strengthened detection and referral of infectious disease (acute respiratory illness, malaria, diarrhea, and measles) through community-based surveillance (CBS) that included door-to-door visits and referrals for care. Also, health promotion sessions and supportive supervision in the 22 health facilities of the implementation contributed to quality of services. The project was able to respond largely to the needs of the target groups, including Community Health Workers (licensed and volunteers); children under five and their caregivers; pregnant and postpartum women and adolescent girls through support to strengthen referral systems, community engagement approaches to improve health behaviors and accountability of the health system as well as capacity building and provision of supplies and equipment to improve health service delivery.
Sustainability
The involvement of community volunteers assisted in the community ownership of the project. At present, community volunteers and community leaders, who benefited from the training conducted by CARE International, are engaged in community mobilization and awareness creation among community members on various aspects of the project. Respondents reported that that through the knowledge gained from CARE international, they were able to strengthen their cooperation among each other. The project has also built the capacity of the local partners and community members in a sustainable way through supportive supervision and training for health care workers and volunteers to improve and enhance their capacity to diagnose and detect infectious diseases. Read More...
The primary objective of the evaluation was to assess the project's performance and document its achievements, challenges, and best practices to guide future similar programming; and provide recommendations to CARE Nigeria and its partners to make informed decisions and enhance the effectiveness and efficiency of future initiatives.
Effectiveness
Evidence from the desk review showed that the project made remarkable progress towards reducing mortality in under-5 children through a community-based health systems strengthening approach that ensures that communities receive a core package of services. The major factors that influenced the effectiveness and achievement of the project results were the use of community structures (community health volunteers, model mothers, and community-based surveillance focal points), capacity building, the referral system and the Social Analysis and Action (SAA) approach through community dialogues, supportive supervision, routine monitoring visits and facility health promotion session. The SAA approach also helped to shift practices related to family planning, immunization and poor health seeking behavior, as evidenced from the qualitative findings.
Efficiency
In both the design and implementation of the project activities, CARE International RIDCU5 team ensured that the project was efficient. The project design allowed the RIDCU5 project to train and work with community members as volunteers and adequately build their capacity and work collaboratively with local partners and relevant stakeholders. The use of community structures and local partners made the project implementation cost effective and created the opportunity for sustainability.
7
The project’s design engaged community volunteers1 to serve as model mothers, community-based surveillance focal points, feedback and accountability volunteers, and community health volunteers, has enabled the project to increase community mobilization through a cost-effective approach. Through the community referral system, and health promotion sessions, many women were reached through the activities of the community volunteers.
Impact
Findings showed that the objectives and activities of the CARE RIDCU5 project were relevant in addressing the humanitarian needs of Bade Local Government communities. The weekly dialogue session with model mothers helped to address social norms and practices that negatively impact maternal and child health and the strengthened detection and referral of infectious disease (acute respiratory illness, malaria, diarrhea, and measles) through community-based surveillance (CBS) that included door-to-door visits and referrals for care. Also, health promotion sessions and supportive supervision in the 22 health facilities of the implementation contributed to quality of services. The project was able to respond largely to the needs of the target groups, including Community Health Workers (licensed and volunteers); children under five and their caregivers; pregnant and postpartum women and adolescent girls through support to strengthen referral systems, community engagement approaches to improve health behaviors and accountability of the health system as well as capacity building and provision of supplies and equipment to improve health service delivery.
Sustainability
The involvement of community volunteers assisted in the community ownership of the project. At present, community volunteers and community leaders, who benefited from the training conducted by CARE International, are engaged in community mobilization and awareness creation among community members on various aspects of the project. Respondents reported that that through the knowledge gained from CARE international, they were able to strengthen their cooperation among each other. The project has also built the capacity of the local partners and community members in a sustainable way through supportive supervision and training for health care workers and volunteers to improve and enhance their capacity to diagnose and detect infectious diseases. Read More...
Rapid Gender Analysis TO SUPPORT THE GOVERNMENT OF SIERRA LEONE TO STRENGTHEN ITS HEALTH SYSTEM
This Rapid Gender Analysis (RGA) report presents findings from the gender and power analysis carried out in November and December 2023 in Falaba, Kambia, Bonthe, Tonkolili, Kenema, Karene, Kailahun, and Pujehun districts of Sierra Leone. The purpose of the RGA is to understand how gender and social norms, roles, relationships, and dynamics influence health outcomes and health-seeking behavior in Sierra Leone, especially for vulnerable populations. The report will inform the development of CARE’s future health programming and proposed interventions for health funding opportunities.
The document is structured into four primary chapters – Background, Methodology, Findings: Results and Analysis, and Recommendations—each containing sub-chapters. The background section outlines the study’s purpose, objectives, and underlying rationale. The methodology section describes the research design, applied approaches, data collection methods and participant information. The study’s key findings are categorized into distinct thematic areas aligned with CARE's Good Practices Framework for Gender Analysis and includes the following Core Areas of Inquiry:
• Household decision-making, division of labor and control of productive assets
• Control over one’s body
• Access to public spaces and services
• Claiming rights and meaningful participation in public decision-making
The RGA also applies the above domains related to health outcomes, behaviors, and health-seeking behavior, including gender dynamics within the Sierra Leone health system with recognition that unequal gender dynamics gaps impact health care providers and their ability to deliver quality services. Finally, the recommendations section outlines actions or interventions CARE should consider in future programming.
Key Findings:
* Men have more influence over decisions for the household than women—including the seeking of healthcare—and women lack control over key decisions related to sex, marriage, and children, including if and when to use contraception. Women’s mobility is limited by social norms which require male permission for movement.
• Contraceptive use is low. Despite around 70% of people knowing about contraceptives and where to get them, only 50% are currently using them. Many community members believe modern forms of family planning are haram or unhealthy, with anecdotal evidence suggesting there is perception that it promotes extramarital affairs.
• Front Line Health Workers (FLHW) face major barriers to effective service delivery: almost half of FLHWs interviewed are unpaid, effectively operating as volunteers, struggle with difficult living conditions and lack of supplies, and report inequitable treatment between male and female workers.
• There is a lack of evidence-based health information for pregnant women: only 27% of pregnant women in the study reported having received any information related to sexual and reproductive health or associated risks.
• Despite generally positive health-seeking behavior, both women and men are concerned by lack of availability of medicine. Read More...
The document is structured into four primary chapters – Background, Methodology, Findings: Results and Analysis, and Recommendations—each containing sub-chapters. The background section outlines the study’s purpose, objectives, and underlying rationale. The methodology section describes the research design, applied approaches, data collection methods and participant information. The study’s key findings are categorized into distinct thematic areas aligned with CARE's Good Practices Framework for Gender Analysis and includes the following Core Areas of Inquiry:
• Household decision-making, division of labor and control of productive assets
• Control over one’s body
• Access to public spaces and services
• Claiming rights and meaningful participation in public decision-making
The RGA also applies the above domains related to health outcomes, behaviors, and health-seeking behavior, including gender dynamics within the Sierra Leone health system with recognition that unequal gender dynamics gaps impact health care providers and their ability to deliver quality services. Finally, the recommendations section outlines actions or interventions CARE should consider in future programming.
Key Findings:
* Men have more influence over decisions for the household than women—including the seeking of healthcare—and women lack control over key decisions related to sex, marriage, and children, including if and when to use contraception. Women’s mobility is limited by social norms which require male permission for movement.
• Contraceptive use is low. Despite around 70% of people knowing about contraceptives and where to get them, only 50% are currently using them. Many community members believe modern forms of family planning are haram or unhealthy, with anecdotal evidence suggesting there is perception that it promotes extramarital affairs.
• Front Line Health Workers (FLHW) face major barriers to effective service delivery: almost half of FLHWs interviewed are unpaid, effectively operating as volunteers, struggle with difficult living conditions and lack of supplies, and report inequitable treatment between male and female workers.
• There is a lack of evidence-based health information for pregnant women: only 27% of pregnant women in the study reported having received any information related to sexual and reproductive health or associated risks.
• Despite generally positive health-seeking behavior, both women and men are concerned by lack of availability of medicine. Read More...
ELLA ALIMENTA AL MUNDO – PERÚ-Informe Final de Evaluación
CARE PERÚ, desde abril 2019 a diciembre 2022 implementa el proyecto “Ella Alimenta al Mundo”- EAM (SFtW - She Feeds the World - por sus siglas en inglés), programa lanzado en varios países por la Fundación PepsiCo a través de CARE USA. El propósito del proyecto ha sido reducir la desnutrición crónica y la anemia en niñas y niños menores de 5 años e incrementar los ingresos de 4,000 familias pobres que residen en 4 distritos priorizados, correspondiente a las provincias de Lima, Ica y Sullana con enfoque de género. El grupo objetivo son niñas y niños menores de 5 años y mujeres gestantes. Read More...
Private Sector Health Facility Assessment USAID Adolescent Reproductive Health (ARH)
USAID Adolescent Reproductive Health (ARH) is a youth co-led initiative to empower girls and boys,10-19 years old, including the most marginalized, to attain their reproductive rights. The project's primary goal is to support adolescents to reach their full potential and strengthen public systems and private entities to create an enabling environment for healthy reproductive health (RH) behaviors by ensuring the readiness of private health facilities to provide adolescent-responsive services.
OBJECTIVES
The study's main objective is to assess most private health facilities meeting USAID ARH specific criteria and identify gaps in providing high-quality services to adolescents. Read More...
OBJECTIVES
The study's main objective is to assess most private health facilities meeting USAID ARH specific criteria and identify gaps in providing high-quality services to adolescents. Read More...
USAID ADOLESCENT REPRODUCTIVE HEALTH A Baseline Study Report
USAID Adolescent Reproductive Health (ARH) is a youth coled initiative to empower girls and boys of 10-19 years,
including the most marginalized, to attain their reproductive health (RH) rights. The goal of the program is to support
Nepali adolescents to reach their full potential by choosing and practicing healthy reproductive behaviors together with the support of their community members.
The baseline study aims to assess the current situation of adolescents' sexual and reproductive health in USAID ARH
working areas (11 districts and 60 municipalities), with specific objectives:
* to identify family planning (FP) and reproductive health (RH) knowledge and practices among adolescents,
exploring mass media exposure and preference among adolescents,
* assess menstrual hygiene practices among adolescents,
* identify factors affecting the age at marriage, and
* identify gender and social norms related to adolescent
SRH issues in the community. Read More...
including the most marginalized, to attain their reproductive health (RH) rights. The goal of the program is to support
Nepali adolescents to reach their full potential by choosing and practicing healthy reproductive behaviors together with the support of their community members.
The baseline study aims to assess the current situation of adolescents' sexual and reproductive health in USAID ARH
working areas (11 districts and 60 municipalities), with specific objectives:
* to identify family planning (FP) and reproductive health (RH) knowledge and practices among adolescents,
exploring mass media exposure and preference among adolescents,
* assess menstrual hygiene practices among adolescents,
* identify factors affecting the age at marriage, and
* identify gender and social norms related to adolescent
SRH issues in the community. Read More...
Elevating Married Adolescents’ Voices for Responsive Reproductive Healthcare in Syria
Increases in early marriage and pregnancy resulting from Syria's humanitarian crisis highlight a critical gap in adolescents' access to life-saving sexual and reproductive health information and services, and a larger need for adolescent-specific interventions grounded in gender transformative approaches. Seeking to address this, CARE, UNFPA and Syria Relief and Development adapted global evidence-based approaches to humanitarian contexts to create the Adolescent Mothers Against all Odds (AMAL) Initiative for pregnant girls and first-time mothers aged 10 to 18 years. Designed to improve the lives of young girls through responsive health systems and enabling environments, AMAL includes three components: a Young Mothers Club for first-time mothers and pregnant girls, participatory dialogues with health providers, and reflective dialogues with girls' marital family and community members. The AMAL Initiative intends to ensure responsiveness to the unique vulnerabilities of adolescent sub-groups by co-implementing with them. Select girls undergo additional leadership training and serve as adolescent representatives on community advisory groups sharing feedback for program improvement. One hundred-four first-time mothers and pregnant girls, 219 community members, and 120 health providers participated in AMAL in northwest Syria. In a mixed methods evaluation, facilitators administered monitoring tools to identify program improvements, pre-post surveys to assess outcomes, and end-line discussions to gather perceptions of impact. Girls reported a 47% overall increase in self-esteem, confidence, health-seeking capacity, and communication ability. Community support for girls' use of family planning increased by 27% and girls' equal access to services by 35%. Findings across all participant groups demonstrate decreased expectations of early marriage and increased acceptance of family planning post-marriage. Areas that participants cited for potential improvement included programming for girls/women above the age of 18 years, and additional training for health providers on long-acting contraceptive methods. These results show that participatory adolescent-centered sexual and reproductive health programming is not only feasible in crisis settings but can improve the self-efficacy of vulnerable adolescents to overcome barriers to accessing healthcare and improving well-being. The AMAL Initiative is now being scaled up through local partners in Syria and piloted in northern Nigeria. Read More...
Uganda: Food insecurity a pressing concern
The Development Initiative for Northern Uganda (DINU) was a 38-month long project (January 2020 to February 2023) with an aim to improve food security, maternal and child nutrition, and household incomes for smallholder farmers in 11 districts of Uganda. The project has three major outcomes: increased production of diversified food by both men and women smallholder farmers, enhanced market accessibility for these farmers, and improved nutrition and family planning services through gender responsive community-based approaches. As a result, here was a significant 16.3% increase in adoption and production of diverse food crops and animal products, as well as 23.8% increase in the adoption of climate-smart technologies among the project participants. Read More...
Development Initiative for Northern Uganda (DINU) Mid Term Evaluation
This Assignment was commissioned by CARE DENMARK – the Lead Partner of the Consortium of five (5) Partner Institutions (namely, CARE; Catholic Relief Services (CRS); Gulu Agricultural Development Company (GADC); Dynamic Agro-Pastoral Development Organization (DADO); and SORUDA) – to carry out the Mid-term Evaluation (MTE) of the “Inclusive Market-based Development for Smallholder Farmers in Karamoja, Teso and Acholi Sub-regions” Project – implemented by the Consortium. The Project is supported by the European Union (EU) – under the Supervision of the Office of the Prime Minister (OPM), through the 11 Project Area District Local Governments of: Abim, Kotido, Karenga, Kaabong, Moroto, Amudat, Nakapiripirit, Nabilatuk, Napak; as well as Katakwi and Kitgum – in partnership with other stakeholders – on behalf of the Government of Uganda.
The Overall Objective of the Mid-term Evaluation (MTE), was to: “review the implementation of the project, since its inception – with the aim of generating evidence towards promoting project performance improvement, accountability, learning and evidence-based decision-making and management”. In particular, the Evaluation was intended to: “assess results achieved to date in comparison with the outcome indicators outlined in the Project Monitoring, Evaluation, Accountability and Learning framework”. Accordingly, the MTE report documents: the background to the Assignment; the general approach to work and methodology employed; Project design (including relevance and coherence); as well as Project management systems, processes and operational environments. It also documents: Project performance and effectiveness during the period under review – up to its mid-term point; as well as the identified major achievements; challenges; constraints; risks; weaknesses and threats that characterized the Project. Lastly, it, further, documents resource management and efficiency in Project implementation; project “impact”; sustainability of Project Interventions and outcomes; the major conclusions; recommendations for the way forward; as well as lessons learnt – over the period under review. Read More...
The Overall Objective of the Mid-term Evaluation (MTE), was to: “review the implementation of the project, since its inception – with the aim of generating evidence towards promoting project performance improvement, accountability, learning and evidence-based decision-making and management”. In particular, the Evaluation was intended to: “assess results achieved to date in comparison with the outcome indicators outlined in the Project Monitoring, Evaluation, Accountability and Learning framework”. Accordingly, the MTE report documents: the background to the Assignment; the general approach to work and methodology employed; Project design (including relevance and coherence); as well as Project management systems, processes and operational environments. It also documents: Project performance and effectiveness during the period under review – up to its mid-term point; as well as the identified major achievements; challenges; constraints; risks; weaknesses and threats that characterized the Project. Lastly, it, further, documents resource management and efficiency in Project implementation; project “impact”; sustainability of Project Interventions and outcomes; the major conclusions; recommendations for the way forward; as well as lessons learnt – over the period under review. Read More...